Overview of Public Health Degree Programs
Our initial dataset from the desk review, supplemented by discussion with key stakeholders in India and literature review, yielded a heterogenous collection of 59 institutions. Of these 59 institutions identified, the breakdown of programs included 25 Master of Public Health (MPH); 20 Master of Science; 14 diplomas; 11 PhDs; four certificates; three executive trainings and two workshops (see Figure 1). This included representation from both private and government institutions, public private partnerships, as well as training hubs outside of traditional academia, including a community health resource center.
*Master of Science (MSc) programs were identified from related disciplines and applications relevant to public health practice, including Epidemiology, Population Studies, Disaster Management, Health Informatics and Applied Nutrition
SWOT Analysis Results
Given the variability of the institutions identified and interviewed, the strengths and weaknesses (internal to each institution) and opportunities and threats (external to particular institutions) identified were not universally represented at all institutions, but rather emerged as common internal and external factors that can enhance or hinder successful public health educational programs and institutions (Figure 2). Themes could be potentially identified as a strength or a weakness depending on the institution itself, and as such we have presented our findings in this paper more as guidance for institutions and stakeholders interested in considerations for their future work or identify solutions to challenges rather than as broad characterizations of the institutions identified.
Key Strengths: Tuition, Innovation, Research
Affordable tuition, particularly at institutions with public funding sources, was recognized as an enabling factor for building public health educational capacity. Tuition fees at such institutions were described in terms like “nominal” and considered financially accessible. Representatives from government universities often juxtaposed the affordability of their own institutions against private universities. Yet this is not necessarily a universal perception, as captured by one representative at a private university
Our fee structure…[is] higher…compared to all other universities or institutions or schools offering similar program in the country. But still, we are able to attract people. Usually, our stake is almost 100% full every time and the reason for this is our reputation.
Additionally, many respondents identified a variety of student support opportunities available, including scholarships, stipends, sponsorship for professional development opportunities like conferences, as well as support reserved for traditionally underrepresented communities like scheduled castes/scheduled tribes (SC/STs).
Intrinsic innovation, or innovation from faculty members and institutional leaders, emerged as a key strength of institutions across the board. This was particularly evident in the context of COVID-19. One interviewee recounted, “the faculty were very significantly involved in directly advising government on a real-time basis, developing protocols, being part of advisory committees…developing guidelines…”
COVID-19 also required institutions to adapt their learning and training programs, which was generally perceived to have been successful. Multiple institutions among those represented already had some level of virtual trainings available before COVID-19 that were able to be quickly scaled, and distance learning was described by one respondent as a well-known modality that had been offered since 1991. Faculty have been successful in teaching courses in an online format, which was made further accessible through universal Wi-Fi across campus. One interviewee summarized what the ability to teach online made possible:
We ensured that there is no disruption in the teaching… I would certainly not say that there some hiccups initially, but clearly, we could learn the new ways of continuing our activities. And we were able to do it well.
One respondent directly stated that, “Our strength is the focus of our research…” Throughout many of our interviews, research capacities and high research productivity were identified as institutional strengths. Several respondents mentioned having their institutional origins rooted in research. Considerable faculty investment, prominent collaborations, in-house expertise and multidisciplinary faculty bodies were some of the cited examples of how these institutions lead and disseminate evidence-based contributions to public health and its related disciplines to India and beyond. High expectations for developing student research competencies were also commonplace.
Key Weaknesses: Collaborations, Lack of Career Pathways and Incentives
Whilst inter- and cross-institutional partnerships and collaborations were the norm and highly valued, many respondents did not feel as though they were always being utilized to their full potential. There was a perceived need to better align common goals, improve working relationships, and better structure interactions. One government university interviewee shared that whilst networks had been established, there existed untapped potential to fully bring out their strengths
There are a lot of things we can learn from each other, the typical rights-based NGOs, typical corporations for profit, typical government institutions... there is a huge opportunity of learning from each other, and I think there is much scope to gain from experiences from each other. That is one thing we would like to improve.
The need for mutually conceived and owned partnerships was also noted, described by one interviewee as, “collaborations on equal footing…the design, the ideation, all of this is there is co-ownership, that is something which is much more appreciated”
Lack of career pathways and incentives
Those working in public health educational institutions sometimes perceived a lack of motivating factors for public health professionals to pursue further qualifications, such as promising career opportunities or perceived lack of prestige. One interviewee further noted that public health trainings were often not rewarded in terms of professional advancement, noting, “Even if you get additional degree [related to public health], in many states it really doesn’t matter…Yes, knowledge wise or skill wise, it will be useful, but not career wise.”
Lack of lucrative or at least dependable compensation, unappealing work conditions and other challenges for graduates of these programs were also raised among public health educators. It was noted that some of the contexts where institutions are located, such as in remote or rural areas, result in challenges to create desirable career opportunities for trainees. It was also mentioned that mentors for emerging professionals (e.g., non-faculty) often could not receive any financial compensation in such roles, straining already lacking human capital.
Key Opportunities: Interest in Public Health, Community Engagement, Technological Advancements
Public health is a growing sphere
The role of COVID-19 in garnering public health awareness and interest was a consistent theme. One interviewee observed that, “public health came to the fore” in recent months as the pandemic has continued. It was mentioned on two separate occasions that, since the pandemic, suddenly everyone seemed to know what an epidemiologist does. A representative from a government institution noted that numbers of applicants for their MPH program “shot through the roof” since the COVID-19 pandemic began, and growth of research activities was also cited by several interviewees, despite many investigations being halted or delayed by COVID-related restrictions.
Whilst evident that the reach of public health is expanding, exactly how it will evolve is less clear, as one interviewee reflected:
COVID has given us an opportunity to work with governments and to get governments to see the advances of working with academic institutions, and I think it could be really interesting to see how many of these opportunities turn into long-term relationships, post-COVID.
Several institutions we spoke with had community engagement opportunities built into their education and research initiatives, noting unique opportunities to present learners with real-world challenges and cultivating soft skills like empathy and adaptability. These collaborations were highly regarded where present. The additional values of bringing in community voices to inform public health priorities was described by one interviewee as follows
I think our greatest strength is that we’re in touch with communities…we noticed there are [often] gaps between what the public health system thinks or what public health as a discipline accepts to what’s actually happening on the ground.
Many respondents felt as though technological adaptations borne from necessity considering COVID-19 restrictions brought new opportunities for public health education institutions. In the case of research activities, for example, one respondent noted that, “one thing that has opened up is this whole thing of online research...using Google Forms, using telephonic interviews, using Zoom…this is going to stay.” Employing digital platforms also brings potential to improve and extend collaboration and communication. Mentees and mentors, researchers and other stakeholders can convene virtually to leverage expertise and foster innovation without the limitation of geographic limitations or the hassle of travelling long distances.
Key Threats: Misaligned Supply and Demand, Officialism, Lack of Urgency
Misaligned supply and demand
Considerable emphasis was placed on the need to harmonize the supply and demand factors of public health training. The demand for individuals with public health qualifications is lacking, as one respondent explained, “There is no recognition of this discipline [public health] as a separate discipline and there are no jobs in the government sector clearly requiring the public health qualifications.” Without clear career pathways upon completion of a public health training, these trainings will remain undersubscribed, whilst an increase in the availability of posts would heighten demands for public health trainings.
The geographic distribution of public health trainees presents an additional challenge to ensure availability of qualified professionals where there is need. Some states have an abundance or “clustering” of qualified trainees, whilst other states continue to lag behind, even with concerted advocacy efforts.
It was also recognized that continued work improving the supply and demand for public health training must be intentional and designed with consideration to health system needs. As summarized by one interviewee:
Since the past 15 years or so, there has been a growth in public health education in the country…but I think there’s a need for…much greater collaboration between the public health educational institutions within the country and abroad, which should be sort of reflexive or self-reflexive…a systematic way of trying to understand what are the human resource needs.
It was mentioned that some bureaucratic processes designed to oversee academic programs could result in overly rigid systems at the institutional level. Factors such as quotas for faculty posts or curriculum mandates that were not necessarily the most up to date were sometimes met with frustration or perceived to limit autonomy. The challenges of balancing these types of mandates with actual needs was further described by one respondent
So, actually the [recommended] combination or the proportion of medical faculty is quite skewed. Now, we have less medical faculty and slightly more non-medical faculty, but the actual posts are, you know, the same that they’re supposed to be.
Lack of urgency
Many interviewees mentioned insufficient capacity to prepare for public health challenges in spite of the pending reality of more severe and frequent major public health events. The inevitability of “the next pandemic” was cited often, as were the increasing complexites of public health challenges (e.g., dual burden of disease, rising inequalities, emerging/re-emerging infectious diseases, epidemiological and demographical transitions). One interviewee summarized the scenario
I hope our policymakers are beginning to realize that these kinds of episodes [like pandemics]are going to get more and more frequent, and also there’s so many other things involved in this. There’s climate change, there’s environmental degradation, there’s urbanization... And, unless we have a really strong primary care network, we’re going to… have to face this kind of a crisis.
It emerged that strengthening public health response will require not only scaling up of the public health workforce but a shift into how they are prepared, phrased by one respondent as “building” public health education from a more interdisciplinary and broader framework.